Joining the Cancer Club

Cancer

. . . joining the club

Sam Broadie is a retired U.S. Army colonel living in the Appalachian foothills north of Atlanta, Georgia. In the

fall of 1993, Sam and I sat on a sofa in his home, watching a baseball game on television. For the better part of

three hours, while the contest played out on the screen, Sam reflected on his recent battle with prostate cancer.

"Ron," he said, "you should get a PSA test."

"What's a PSA test?" I asked.

"The PSA test is a simple blood analysis," Sam replied. "A few drops are extracted from a finger and sent to

a lab for measurement to see how much 'prostate specific antigen' the prostate gland is secreting into the blood-

stream. An elevated PSA could indicate that cancer is present. Every man should have a PSA test by age fifty."

Sam had always believed that he received first-class medical care in the Army. As a young officer, he was

given a complete physical exam every five years. Beyond age forty, the examinations increased to once a year.

In the late spring of 1990, having recently turned fifty years old, Sam reported to the base hospital for his final

physical examination prior to retirement from the Army. The examining doctor saw no need to look beyond the

traditional digital rectal exam (the infamous "finger wave") and pronounced Sam fit for release into civilian society.

It wasn't until Sam visited a local Atlanta doctor a couple of years later that he finally received his first PSA test,

and prostate cancer was discovered. The civilian doctor said that the cancer had been present up to eight years!

Having narrowly survived his own ordeal, Sam embarked on a mission to enlighten others. It dismayed him to

discover how little most men knew, or cared, about the subject of prostate disease. Speaking to an audience of

one that day, Sam stressed the importance of awareness and regular testing. "Ron," he said, "at forty-six years

old, you are fast approaching the danger zone. You need to get yourself tested, and sooner rather than later."

Despite Sam's urging, I felt no great rush to get tested. My fiftieth birthday still lay four long years in the future.

Besides, Sam's case was an exception. Prostate cancer attacks old geezers, not healthy young studs like me.

* * * * *

Actually, I understood the importance of preventive medical screening and had every intention of submitting to

a PSA test but, for one reason or another, kept putting it off. As months passed into years, Sam Broadie's voice

rose from my subconscious, like a foghorn in a storm, "Early detection is key to survival. Don't wait too long!"

Finally, a few days past my fifty-first birthday, I scheduled a physical exam and asked my German doctor to

also administer a PSA test. He stared at me for a moment, nodded his head, and said, "Sure, if you want one."

A healthy adult male secretes between 0 and 4 nanograms (one billionth of a gram) of prostate specific antigen

per milliliter of blood. My first PSA test resulted in a score of 9.9, followed one month later by 10.7, thoroughly

alarming my doctor who immediately referred me to a urologist who passed me on to a hospital for a biopsy.

Surprisingly, the biopsy was negative. Over the next five years, four urologists in three countries administered

a total of fifteen PSA tests and five biopsies, all of which were negative. My scores rose from that first 9.9 in 1998

to a staggering 34.0 in July 2003; but, to the amazement of everyone involved, not a single cancer cell was found.

One urologist opined that I fell into a rare group of men who, for no discernable reason, display unnaturally high

PSA levels. A second claimed, "I've treated 600 prostate cancer patients, and you do not have cancer." A third

swore, "There's cancer in there, I just can't find it." All did agree, however, to continue monitoring the situation.

* * * * *

Back home in Switzerland in September 2003, familiar symptoms began to surface, suggesting a kidney stone

might be working its way down toward my bladder. A thorough examination by my urologist revealed nothing, and

that included cancer, so I packed a bag and departed for a two-month stay at our condominium in Florida.

Two weeks later, the pains near my bladder continued. One day, I awoke with a throbbing headache that would

not go away. Normally, like most men, I will give a nagging pain a chance to heal of its own accord before seeking

the services of a physician, but this time felt different; an invisible hand kept nudging me toward the telephone.

A neighbor recommended a local urologist with impressive credentials, a board certified "fellow" affiliated with a

highly respected clinic. Sitting in his office, I recited my medical history and produced substantiating documents.

Mulling through the papers, the doctor recommended a cystoscopy, a procedure to examine the bladder, ureters,

and kidneys. "By the way," he said, "as long as you will be asleep, do you mind if I also perform another biopsy?"

Being on the receiving end of a prostate biopsy is not a pleasant experience, even if you are under anesthesia.

A fair amount of bleeding occurs, and full recovery can take several weeks. No man ever volunteers for a biopsy.

I had one five weeks before, with the usual negative results, and did not relish the idea of enduring another one so

soon there after, but a soothing voice from somewhere deep within reassured me that this one was necessary.

"Sure, Doc, knock yourself out," I replied.

* * * * *

Talking to the doctor afterward felt a lot like having a discussion with an auto mechanic who cannot locate the

noise in your car that has been driving you nuts. No, the doctor assured me, he had not found any evidence of

kidney stones in my system. "Well, then, what is the source of all those strange pains I have been experiencing?"

"Can't say," he replied, "but the biopsy results do show some cancer."

Cancer. After five years of worrying, false hopes, and then putting the thought behind me, the dreaded diagnosis

had finally arrived. Funny, it brought no shock or fear. The fact simply registered; then something like relief swept

over me, as though to say, "Well, it's about time! Now we can get on with the treatment."

Three previous urologists stuck nearly forty needles in me, searching specifically for cancer, and found nothing.

This guy, on the prowl for a phantom kidney stone, strikes cancer. Such are the vagaries of modern medicine.

Of twelve needle probes, three tested positive for cancer. Lab results suggested an early stage, and a Gleason

Scale of six indicated moderate aggressiveness. No evidence existed of spread beyond the prostate; so, given my

age, condition, and life expectancy, the doctor recommended a radical prostatectomy -- surgical gland removal.

* * * * *

Nothing happens quickly in the world of medicine. Twixt diagnosis and the operating room, interminable delays

occurred for various tests, exams, x-ray's, and blood storage. On January 19, 2004, I finally went under the knife.

The operation went smoothly, but the post-op pathology report contained a surprise: more cancer than expected,

located in the upper central region of the gland, growing up to the margin. A malignancy there is quite abnormal.

Cancer in the upper region is so rare that most doctors don't bother probing there, concentrating instead on the

lower portion where the disease is expected to appear, which answers the riddle of why five previous biopsies came

back negative. Because the other doctors had not expected to find cancer higher up, they simply didn't test there.

My surgeon had no way of knowing any of this beforehand, so he could not say afterward whether his scalpel

had severed the cancer's line of advance, or not. "The odds are fifty-fifty," he said. The results of your next PSA

test will give us a start point, then we will have to monitor the situation very closely for the next four years, or so."

Epilogue I

For twenty months following surgery, PSA results remained undetectable; but, in September 2005, a positive

reading came back, indicating that a small amount of cancer might still be present. Two more tests, six months

apart, indicated a slight and gradual increase. My doctor said not to worry, that we can fight this slow-growing

malignancy for many years, and I will most likely die of old age before the cancer gets me; but, just to be sure

the good doctor and I understood each other, I reminded him that my definition of "old age" is ninety-eight. He

laughed and said, "Well, we might not make it quite that long."

One thing is certain: regular PSA testing is now an integral part of my life.

(P.S. In May 2005, The U.S. Department of Veterans Affairs officially determined that my prostate cancer

resulted from exposure to the herbicide "Agent Orange," a chemical defoliant sprayed extensively by U.S. military

forces throughout the Republic of South Vietnam, as well as near the demilitarized zone (DMZ) in Korea where I

manned a foxhole in spring 1969. The use of Agent Orange during the Vietnam conflict has received widespread

publicity; however, its use in Korea has rarely been mentioned. Only by coincidence did I discover a newspaper

article listing potentially infected units in Korea (mine included) prepared by the U.S. Department of Defense and

provided to the U.S. Department of Veterans Affairs. It is unfortunate that this disclosure did not occur earlier, as

the information might have proved extremely enlightening to the physicians treating my symptoms over the years.)

Epilogue II

By October 2006, my urologist became convinced that a small amount of cancer remained in my prostate bed

and was growing. Once he reached that conclusion, we agreed upon a program of external beam radiation. The

treatments began October 18 and ended December 6, 2006, thirty-five visits in all, Monday through Friday of each

week. The oncologist stated that current dosages were significantly stronger than those administered five years

prior, and he expressed confidence that this aggressive approach would eradicate my few remaining cancer cells.

Epilogue III

By March 2007, three months since radiation treatments ended, a new blood sample, produced a PSA score of

"<0.03" (less than zero point zero three), which represented the smallest value that particular laboratory equipment

could measure. In essence, the test equipment found no trace of PSA in my blood. This good news was exactly

what we had hoped for; however, my doctor cautioned against premature celebration. In fact, he said we will have

to continue monitoring my PSA level for up to eight more years before declaring the disease gone, if even then.

Epilogue IV

April 2010 has arrived. For the past three years, biannual blood tests have failed to detect any trace of PSA in

my system, raising our outlook to "cautiously optimistic." I don't dwell on the presence or absence of the disease

anymore; rather, I concentrate on the beauty of each morning and the woman with whom I am privileged to share it.